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Essential Secrets of Psychotherapy

Clinical wisdom for you in honor of National Psychotherapy Day.

Tuesday, September 25th, marked the first celebration of National Psychotherapy Day. National Psychotherapy Day is the brainchild of PT blogger and clinical psychologist Dr. Ryan Howes, who deserves credit and congratulations for conceiving of, organizing, and getting it off the ground.

In honor of National Psychotherapy Day, I will be posting a series of my previously published pieces on the practice of psychotherapy. A different posting each day this week, Monday through Friday. In effect, extending National Psychotherapy Day into National Psychotherapy Week here at Psychology Today. Hope you enjoy!

What really happens in psychotherapy? The answer to that question is complex. And depends in part on the type of psychotherapy one seeks. And who provides it. But one thing psychotherapy can convey to patients are certain essential secrets to living a more rich, meaningful, creative, balanced life. What are some of these traditional, time-honored secrets? Here, in Part Three (see One and Two) of Essential Secrets of Psychotherapy, are, in no special order, seven more highly distilled offerings of powerful clinical wisdom for your consideration. I hope readers find one or two that synchronistically speak to them and their own specific concerns.

Forgiveness cannot be forced. Giving someone your forgiveness prematurely, prior to really feeling it, is not in your best interest. Yes, it's good and spiritually "correct" to forgive those who have hurt us or somehow negatively impacted our lives. It may make those receiving your forgiveness feel better about themselves and less guilty. But it is not natural. Not at first. And, frequently, not for some time. Forgiveness is a basic psychological process, and the process must be honored and slowly worked through in order for forgiveness to occur. When we are ready, forgiveness seems to happen. And not a moment sooner. But, at the right time, forgiveness is fundamentally an existential choice: to hang on to anger, resentment, hatred and rage or to finally let it go. And perhaps harness or redirect that rage for productive purposes. Forgiveness can, in a sense, be considered a constructively selfish choice, since it is ultimately psychologically beneficial to relinquish toxic resentment and embitterment. (See my prior post.) But to feel angry or resentful about having been insulted, violated, abandoned, abused or victimized is natural, totally normal, and must be where the forgiveness process starts. Where we are. Not where we would like to or feel we should be, spiritually or philosophically speaking. In this sense, being righteously angry, properly pissed-off, accepting and honoring rather than minimizing one's rage and inherent right to be furious, is the first courageous step on the sometimes long and painful path toward forgiveness. Forgiveness, of course, is not the same as forgetting. We can, in due time, forgive even those who refuse to acknowledge their injurious actions--though this makes forgiveness exceedingly more difficult than granting it to those who do. But to forget bad behavior is foolish. And dangerous. Forgiveness is fundamentally an expression of spiritual compassion for the evil deeds of our fellow humans, malicious or unintentional, and an acceptance of the hidden shadow in us all. But it must never become a naive, blind denial of the deep-seated and pervasive human capacity for evil. Forgiveness, like charity, at best, begins at home: Learning to forgive ourselves for our own mistakes and misdemeanors can help to feel more compassion and forgiveness toward others. In turn, practicing forgiveness of others can make us more forgiving of our own frailties, weaknesses and missteps.

Anger is your ally. Anger is one of the most maligned human emotions. This demonization of anger is manifest in many spiritual or religious traditions. And even, or perhaps especially, in mental health professionals, who typically vilify and misperceive anger or rage as purely negative, destructive, dangerous and irrational, and therefore seek to suppress it in their patients and themselves psychopharmacologically and/or psychotherapeutically. That is an immense mistake. You have a right to your anger. You need it. Anger, when properly related to, is a vital source of strength, energy and empowerment. Yes, of course, anger can be devastatingly destructive and dangerous. And frequently pathological. But, while it may sometimes require psychiatric intervention such as medication or hospitalization to control runaway rage and prevent violence, suppressing one's anger over time rather than addressing it makes it even more dangerous. What is needed is a recognition and validation of our anger and some means of expressing or redirecting it constructively rather than destructively. Being able to verbally express one's rage and connect it consciously to its true source, rather than unconsciously acting it out, is an important aspect of any worthwhile "anger management" program. Anger, is not, as many believe, antithetical to spirituality. Nor to mental health. On the contrary, accepting one's anger is the start of spiritual wisdom, as well as a key to therapeutic progress. And, paradoxically, increased creativity. Here is a secret that psychotherapy patients and many artists come to know: Anger is closely correlated with creativity: As Rollo May wrote, "Our culture requires that we repress most of our anger, and, therefore, we are repressing most of our creativity." So the secret is in finding ways to use one's anger or rage creatively rather than suppressing or expressing it destructively. (See my prior post.)

Love always hurts. We like to think of love as a joyful, uplifting, experience. And it can be. But love also has a dark side. Opening oneself up to love is risky and dangerous business. Many psychotherapy patients intuitively know this, which is why they resist doing so. (See my prior post on "love phobia." ) Almost always, they have been previously burned, by parents or friends or lovers. Some defend against love consciously, others unconsciously. But, at the same time, they know they are missing out on something vitally important, primal and meaningful in their lives. Something that can serve to assuage and transcend at least part of our existential loneliness. Falling in love is like being infected: We have been deeply and irrevocably affected by encountering another, and are made aware of a powerful, unbidden, irrational process being, for better or worse, inexorably set into motion within us. There are archetypal symptoms of "love infection," as with influenza, for example. And, when one's love is unreciprocated, taken for granted or rejected, the pain and suffering is excruciating. The secret about love is that such suffering can teach us much about ourselves and life if we learn to see it psychologically and utilize it productively: Love is a two-edged sword. It can hurt. But it can also heal. (See my prior post on the "love cure.") Being willing to love despite love's dark side is a courageous affirmation of life.

Swallowing the "bitter pill." We can't change the past. There are no magic bullets for undoing what has been done. No therapeutic techniques for permanently erasing trauma from memory. No way to unring a bell. This is one of the hardest and most painful facts of life for psychotherapy patients to come to terms with. They have been trying all their lives to run away from or deny the reality of what took place during childhood, be it physical, emotional or sexual abuse, literal or emotional abandonment, rejection or neglect. Perhaps the most painful, poignant and pivotal point during psychotherapy comes when, much like Oedipus, one confronts the true facts of one's own history. Some childhood wounding or trauma is inevitable in this imperfect world. In order to survive, both physically and psychologically, such trauma is often defended against in the form of childhood amnesia. In adulthood, emotional laceration may be recognized, made conscious, placed in a wider perspective, and, sometimes, even healed. But "healing" (like forgiveness) does not mean forgetting, for to become conscious is to remember and to know. Healing entails the mature acceptance of the traumatic facts of one's emotional mortification, the causes and the consequences, as well as a resolute willingness to swallow the following "bitter pill" : We cannot change the past nor undo the wound. Nor can we realistically hope as adults to now magically receive that which, in so many cases, brought about the original wounding by dint of its absence during infancy, childhood or adolescence. We can never return to undo what was done to us. To receive what we never received from parents or caretakers. We can, nonetheless, allow ourselves to feel our rage and grief over this irretrievable loss. We have the power to decide our attitude toward the past. We may even--with good fortune, time and grace--find within ourselves the capacity to forgive those who we feel inflicted our agonizing injuries. But we cannot expect to totally exorcise such "demons." They have taken up permanent residence. Become an integral part of us. Molded our personality. Made us who we are today. Partaking of the "bitter pill"--which includes admitting embitterment about childhood history--is typically the true turning point in therapy, as patient's start to move toward accepting the past rather than trying to forget, distort or change it, living more in the present, and looking ahead toward the as yet undetermined future. The empowering secret psychotherapy patients discover is that though the unpalatable "bitter pill" may taste terrible and feel toxic at first, it unexpectedly turns out to be emotionally medicinal and healing.

Even victims are responsible for their attitude and actions. This is one of the most controversial (and politically incorrect) secrets of psychotherapy. It is commonly angrily misunderstood as "blaming the victim." But it is far from that. Still, patients who have been victimized in some way or another tend at times to fall into what psychologist Martin Seligman called "learned helplessness" : An embittered, defeated feeling of being victimized by fate and powerless to determine our own destiny. We are all victims of life. Of events--sometimes random or unintentional, others malicious and evil-- we did not choose and over which we had no control. Nor responsibility. But we are responsible for how we deal with such events. It is always much easier and more convenient to blame our problems on others than to accept responsibility for our personal response to victimization. Existentially speaking, like it or not, we are responsible for how we cope with our victimhood, how we interpret it, and how we learn from it. In addition, there are countless evils beyond our control that can befall us at any time. There are others which we sometimes unwittingly (i.e., unconsciously) invite or make more likely by our own attitudes and actions. We, as adults, must continually grapple with the question of whether "unconsciousness"--that is, not knowing what one is doing, or why--automatically exculpates. Christ's famous biblical cry from the cross, "Father, forgive them; for they know not what they do" (Luke 23:34 AV), appears at first to condone exoneration for "not knowing" the full implications of one's actions. But, as existential analyst Rollo May (1972) points out, " We are responsible for the effect of our actions, and we are also responsible for becoming as aware as we can of these effects." Psychotherapy patients discover how to differentiate between being purely a victim of fate, an unconscious but still at least partly responsible participant in victimhood, and what it means to consciously find and fulfill one's own destiny. The secret, as existential psychiatrist Viktor Frankl suggested, is to see how our often unconscious "schema" (CBT), "guiding fiction" (Adler) or "myth" (May) and conscious attitude taken toward being a victim can perpetuate feelings of powerless victimhood rather than empowering us to transcend it. Victim mentality fosters a vicious cycle of further victimhood. Disidentifying with the victim role helps to break that vicious cycle.

The wisdom of insecurity. When our most disturbing fears and worries are carefully examined and carried out to their logical conclusions, death and death anxiety is often (but not always) what we find lurking there. Fear of death. Fear of Hell. Fear of reincarnation. Fear of nothingness, the void or oblivion. Fear of physically suffering. As Woody Allen once put it, "I'm not afraid of death. I just don't want to be there when it happens." Ernest Becker, in The Denial of Death (1973), counsels wisely that one must "consent daily to die, to give oneself up to the risks and dangers of the world, allow oneself to be engulfed and used up. Otherwise one ends up as though dead in trying to avoid life and death." True enough. But what happens when we no longer dread death, but rather accept it as merely the necessary counterpart to life, as darkness is the counterpart to light? When we embrace suffering as the necessary counterpart to joy, pleasure and happiness? Opposite poles of the same existence. And when we see that there really is no such thing as security in life. Except for that sense of security that originates within. A spiritual rather than physical or material security. An internal rather than external source of security. We arrive at an essential secret, what philosopher and theologian Alan Watts called the "wisdom of insecurity." We realize that our constant worrying was always a way of denying these fundamental facts. Of escaping the present. Of avoiding our existential anxiety. Of trying to convince ourselves that we can have more control over life than we actually do. Relinquishing our illusions of control, accepting our relative powerlessness over life and death, and accepting ourselves as we are--including our anxiety and life's utter unpredictability--can be extremely liberating. It can allow us to stop worrying so much, and get on with living. The mysterious future will unfold soon enough. Make necessary plans and decisions. But don't dwell on them or be overly attached to their desired outcomes. Focus instead on what's happening right now, this very moment, however anxiety-provoking, painful, tedious or infuriating rather than anxiously anticipating what may or may not happen next. The future is never guaranteed, one way or another. It may or may not ever arrive. Something bad could happen. But, then, so could something good. Rather than hopeless pessimism or grandiose expectation, consider adopting an attitude of "benign optimism" (or at least neutrality) toward the potential but never promised future.

The paradoxical power of No. For many psychotherapy patients, saying No is one of the hardest things to do. They don't want to hurt anyone's feelings. They don't want anyone to be angry with them. They don't want to disturb the status quo. They don't want to be rejected or abandoned. They don't want to be perceived as being negative, rigid, selfish, difficult, stubborn or uncooperative. But what they don't realize is that saying No is an essential assertion of one's will in the world. To say No is to express one's existence. And one's personal power to assert and defend one's being. We see such necessary self-assertion developmentally in toddlers during the "terrrible two's." To say No is to differentiate oneself from others and a manifestation of our existential freedom. Sadly, saying No is often met with punishment and negative consequences, during childhood and later, which gradually leads to a loss of self and self-esteem. We then feel we haven't the right to say No. This incapacity to say No is at the core of what today is called "co-dependency." And it insidiously contributes to the passivity, hopelessness and helplessness of depression and other mental disorders. Psychotherapy patients tend to see saying No as an expression of both selfishness (see my prior post) and negativity. Yet, the secret is that one is not truly capable of fully saying Yes to something or someone if he or she cannot first say No. How can one freely choose something or someone for themselves when unable to freely decline that choice? Certainly saying No can, and often is, a negativistic expression of will, what depth psychologist Otto Rank called "counterwill." For some, such pervasive negativism or oppositional behavior (seen, for instance in the adolescent's Oppositional Defiant Disorder), has become the only way they know how to assert themselves and their will in the world. But to oppose something can be a form of empowerment, as, for instance, in the case of the Occupy Wall Street protest movement today. The same is true in romantic relationships. One cannot fully say Yes to a love relationship without first being able to say No to it. Real intimacy requires the tension and interplay between two independent wills. Without the ability to say No, to set boundaries and limits (see my prior post) in relationship, there can be no genuine intimacy or commitment. Only chronic acquiescence and, consequentially, underlying, typically unconscious resentment and bitterness. As well as constant fear and dread of being engulfed, overpowered, controlled, smothered or even annihilated by the other. Then No tends to take the form of passive-aggressive behaviors, neurosis and, in some cases, psychosis or suicide: the ultimate refusal to participate in and total rejection of external reality. But, paradoxically, knowing that we possess the power to say No to life can encourage us to embrace it. Saying No at times to others and the world takes tremendous courage. But it is a crucial prerequiste to discovering one's true self. To finding and fulfilling one's destiny. And to ultimately being able to say Yes to love and to life.

So there you have it: Seven additional pearls of hard-won clinical wisdom for you to celebrate National Psychotherapy Day this week, the fourth of five postings concluding on Friday.

This series is based on and distilled from Dr. Diamond's forthcoming book, Essential Secrets of Psychotherapy: The Healing Power of Clinical Wisdom. All rights reserved.